An article in Health Services Research examines whether permanent supportive housing (PSH) for chronically homeless individuals reduces the use of acute health care services, compared to the usual assistance offered to people experiencing homelessness. The authors find that permanent supportive housing is associated with a 38% reduction in the use of psychiatric emergency departments and nearly two-thirds fewer days in shelters. Residents in permanent supportive housing had twice as many outpatient mental health visits as those receiving usual care. The study did not find a significant reduction in hospitalizations or other visits to medical emergency departments.
The authors conducted a randomized controlled trial among 423 chronically homeless high users of multiple county-funded systems (e.g., emergency departments, inpatient services, jail) in Santa Clara, California. They assessed service use by examining administrative claims data between 2015 and 2019. The project is ongoing. The study’s participants were randomly assigned into two groups: a group receiving the usual care provided to homeless individuals in the community and a group immediately assigned to PSH. The 224 participants assigned to usual care were eligible for the services typically provided to individuals experiencing homelessness in Santa Clara County, which could include shelter, temporary or permanent housing, and other forms of PSH, when those services are available. The 199 participants assigned to the intervention were enrolled in Project Welcome Home, a PSH project that utilizes both scattered-site and congregate housing. Participants in Project Welcome Home received weekly case management for six to nine months, a rental subsidy, an array of housing options delivered through a Housing First approach, and other supportive services including mental health services, medication support, educational and vocational support, and connection to primary care.
During the follow-up period, 86% of those assigned to the PSH intervention received housing, compared to 36% of those receiving usual care. On average, participants in the PSH intervention moved twice after entering the program, and 72% of those who moved had no housing gap between placements. Individuals in the PSH intervention spent an average of 6.6 days in shelter per year, compared to 16.8 days for individuals in the usual care group.
Assignment to the PSH intervention was associated with a 38% reduction in psychiatric emergency department visits. PSH residents, however, had nearly twice as many outpatient mental health visits as individuals receiving usual care. There were no statistically significant differences between PSH and usual care in total use of emergency departments, in hospitalizations, or in jail stays.
The authors infer that experiencing homelessness is one factor that leads to emergency department visits among psychiatric patients, and that such visits may be reduced by providing housing associated with low-barrier mental health services. People who are high users of such services likely have unmet health needs that become apparent once housed. By providing housing with appropriate services, the vast majority of high-risk individuals can remain stably housed. Because over two-thirds of PSH participants required rehousing after their first placement, the authors caution that any successful program will require flexibility.
The full article can be found at: https://bit.ly/2HDa7u5